DVd(T)方案治疗多发性骨髓瘤17例临床疗效分析

Pegylated liposomal doxorubicin in combination with vincristine and reduced-dose dexamethasone and thalidomide for the treatment of multiple myeloma

目的:观察脂质体阿霉素(PLD)联合长春新碱(VCR)、地塞米松(Dex)±沙利度胺(Thal)治疗多发性骨髓瘤(MM)患者的疗效及毒副反应。方法:17例初治或复发难治MM患者接受DVd(PLD40mg·m-2 d1、VCR2mg d1、Dex40mg d1～4)或DVdT(PLD及VCR用法用量同上,Dex:40mg,d1～4、d9～12;Thal:100mg,d1～21)治疗,按照EBMT标准评价疗效、WHO标准判断毒副反应。结果:①17例患者共完成了34个周期的治疗,总有效率(ORR=CR+nCR+VGPR+PR)为58.8%,与国外文献报道接近,与历史上我院采用的VAD及其类似方案相比疗效也接近。②采用DVd方案治疗的11例患者的ORR为4/11(36.4%)。其中6例初治患者的ORR为2/6(33.3%)。采用DVdT方案化疗的6例患者均为初治病例,其ORR为6/6(100%)。对于初治患者,DVdT方案的ORR显著好于DVd方案。③多数治疗相关毒副反应为1～2级且可耐受。17例患者中有13例在接受DVd(T)化疗前心电图或心脏B超示不同程度的心律失常或左室舒张功能降低,但均未因化疗增加心脏毒性。DVd组与DVdT组的毒副反应接近。结论:DVd方案具有较好的耐受性,适当延长Dex用量并加入Thal可以在不增加化疗相关毒性的同时显著提高DVd方案疗效。

Objective：To investigate the efficacy and toxicity of pegylated liposomal doxorubicin（PLD） , vincristine（VCR）, reduced-dose dexamethasone（Dex） and thalidomide （Thai） was treated with patients in multiple myeloma （MM）. Method： 17 new diagnosed or relapsed/refractory myeloma patients were treated with DVd（VCR 2 mg and PLD 40 mg/m^2 were administered as single dose on day 1, and dexamethasone 40 mg daily on day 1 to 4） or DVdT（VCR and PLD were given in the same dose as DVd group, Dex 40 mg daily on day 1 to 4 and day 9 to 12, Thal was given daily 100 mg at bedtime）. Response was evaluated according to the criteria of the European Group for Blood and Marrow Transplantation（EBMT）. Adverse events were graded according to the Word Health Organization （WHO） criteria. Result： O17 patients received 34 cycles of treatment. The overall response rate （ORR=CR＋nCR＋VGPR＋PR） was 58.8%, which was similar to literature reports;（2）ORR of new diagnosed patients treated with DVd regimen was 33.3%（2/6）, which was significant lower than the ORR of patients treated with DVdT（6/6,100%） ; （3）The most common adverse events were 1 - 2 grade. Conclusion.. The combination of vincristine, liposomal doxorubicin, and dexamethasone is a well-tolerated treatment.